Population Research and Policy Review

, Volume 35, Issue 5, pp 581–597 | Cite as

Caregiver Decision-Making: Household Response to Child Illness in Sub-Saharan Africa

  • Hayley Pierce
  • Ashley Larsen Gibby
  • Renata ForsteEmail author


We draw upon a framework outlining household recognition and response to child illness proposed by Colvin et al. (Soc Sci Med 86:66–78, 2013) to examine factors predictive of treatment sought for a recent child illness. In particular, we model whether no treatment, middle layer treatment (traditional healer, pharmacy, community health worker, etc.), or biomedical treatment was sought for recent episodes of diarrhea, fever, or cough. Based on multinomial, multi-level analyses of Demographic and Health Surveys from 19 countries in sub-Saharan Africa, we determine that if women have no say in their own healthcare, they are unlikely to seek treatment in response to child illness. We find that women in sub-Saharan Africa need healthcare knowledge, the ability to make healthcare decisions, as well as resources to negotiate cost and travel, in order to access biomedical treatment. Past experience with medical services such as prenatal care and a skilled birth attendant also increases the odds that biomedical treatment for child illness is sought. We conclude that caregiver decision-making in response to child illness within households is critical to reducing child morbidity and mortality in sub-Saharan Africa.


Sub-Saharan Africa Demographic and Health Surveys Child illness Caregiver Decision-making Treatment 


  1. Abuya, B. A., Ciera, J., & Kimani-Murage, E. (2012). Effect of mother’s education on child’s nutritional status in the slums of Nairobi. BMC Pediatrics, 12, 80.CrossRefGoogle Scholar
  2. Adekanmbi, V. T., Kayode, G. A., & Uthman, O. A. (2011). Individual and contextual factors associated with childhood stunting in Nigeria: A multilevel analysis. Maternal & Child Nutrition, 9, 244–259.CrossRefGoogle Scholar
  3. Ahorlu, C. K., Koram, K. A., & Weiss, M. G. (2007). Children, pregnant women and the culture of malaria in two rural communities of Ghana. Anthropology and Medicine, 14, 167–181.CrossRefGoogle Scholar
  4. Alldendorf, K. (2010). The quality of family relationships and use of maternal health-care services in India. Studies in Family Planning, 41, 263–276.CrossRefGoogle Scholar
  5. Beiersmann, C., Sanou, A., Wladarsch, E., De Allegri, M., Kouyate, B., & Muller, O. (2007). Malaria in rural Burkina Faso: Local illness concepts, patterns of traditional treatment and influence on health-seeking behaviour. Malaria Journal, 6, 106.CrossRefGoogle Scholar
  6. Blum, L. S., Sharmin, T., & Ronsmans, C. (2006). Attending home vs. clinic-based deliveries: perspectives of skilled birth attendants in Matlab, Bangladesh. Reproductive Health Matters, 14, 51–60.CrossRefGoogle Scholar
  7. Chakraborty, P., & Anderson, A. K. (2011). Maternal autonomy and low birth weight in India. Journal of Women’s Health, 20, 1373–1382.CrossRefGoogle Scholar
  8. Chen, J., Xie, Z., & Liu, H. (2007). Son preference, use of maternal health care, and infant mortality in rural China, 1989–2000. Population Studies, 61, 161–183.CrossRefGoogle Scholar
  9. Cho, Y., Song, S., & Frisbie, W. P. (2005). Adverse birth outcomes among Korean Americans: The impact of nativity and social proximity to other Koreans. Population Research and Policy Review, 24, 263–282.CrossRefGoogle Scholar
  10. Chuma, J., Gilson, L., & Molyneux, C. (2007). Treatment-seeking behaviour, cost burdens and coping strategies among rural and urban households in Coastal Kenya: An equity analysis. Tropical Medicine & International Health, 12, 673–686.CrossRefGoogle Scholar
  11. Colvin, C. J., Smith, H. J., Swartz, A., Ahs, J. W., de Heer, J., Opiyo, N., et al. (2013). Understanding careseeking for child illness in sub-Saharan Africa: A systematic review and conceptual framework based on qualitative research of household recognition and response to child diarrhea, pneumonia and malaria. Social Science and Medicine, 86, 66–78.CrossRefGoogle Scholar
  12. Comoro, C., Nsimba, S. E., Warsame, M., & Tomson, G. (2003). Local understanding, perceptions and reported practices of mothers/guardians and health workers on childhood malaria in a Tanzanian district—implications for malaria control. Acta Tropica, 87, 305–313.CrossRefGoogle Scholar
  13. Deressa, W., Ali, A., & Hailemariam, D. (2008). Malaria-related health-seeking behaviour and challenges for care providers in rural Ethiopia: Implications for control. Journal of Biosocial Science, 40, 115–135.CrossRefGoogle Scholar
  14. Ellis, A. A., Winch, P., Daou, Z., Gilroy, K. E., & Swedberg, E. (2007). Home management of childhood diarrhoea in southern Mali—implications for the introduction of zinc treatment. Social Science and Medicine, 64, 701–712.CrossRefGoogle Scholar
  15. Falade, C. O., Ogundiran, M. O., Bolaji, M. O., Ajayi, I. O., Akinboye, D. O., Oladepo, O., & Adeniyi, J. D. (2005). The influence of cultural perception of causation, complications, and severity of childhood malaria on determinants of treatment and preventive pathways. International Quarterly of Community Health Education, 24, 347–363.CrossRefGoogle Scholar
  16. Finlay, J. E., Özaltin, E., & Canning, D. (2011). The association of maternal age with infant mortality, child anthropometric failure, diarrhea and anemia for first births: evidence from 55 low- and middle-income countries. BMJ Open, 2, e000226.Google Scholar
  17. Frankenberg, E., Suriastini, W., & Thomas, D. (2005). Can expanding access to basic healthcare improve children’s health status? Lessons from Indonesia’s ‘Midwife in the Village’ Programme. Population Studies, 59, 5–19.CrossRefGoogle Scholar
  18. Friend-du Preez, N., Cameron, N., & Griffiths, P. (2009). Stuips, spuits and prophet ropes: The treatment of abantu childhood illnesses in urban South Africa. Social Science and Medicine, 68, 343–351.CrossRefGoogle Scholar
  19. Frost, M. B., Forste, R., & Haas, D. W. (2005). Maternal education and child nutritional status in Bolivia: Finding the links. Social Science and Medicine, 60, 395–407.CrossRefGoogle Scholar
  20. Gribble, J. N., Murray, N. J., & Menotti, E. P. (2009). Reconsidering childhood under nutrition: Can birth spacing make a difference. An analysis of the 2002–2003 El Salvador National Family Health Survey. Maternal and Child Nutrition, 5, 49–63.CrossRefGoogle Scholar
  21. Hayford, S. R. (2005). Conformity and change: Community effects on female genital cutting in Kenya. Journal of Health and Social Behavior, 46, 121–140.CrossRefGoogle Scholar
  22. Heuveline, P., & Goldman, N. (2000). A description of child illness and treatment behavior in Guatemala. Social Science and Medicine, 50, 345–364.CrossRefGoogle Scholar
  23. Hildenwall, H., Rutebemberwa, E., Nsabagasani, X., Pariyo, G., Tomson, G., & Peterson, S. (2007). Local illness concepts—implications for management of childhood pneumonia in eastern Uganda. Acta Tropica, 101, 217–224.CrossRefGoogle Scholar
  24. Kamat, V. R. (2006). “I thought it was only ordinary fever!” cultural knowledge and the micropolitics of therapy seeking for childhood febrile illness in Tanzania. Social Science and Medicine, 62, 2945–2959.CrossRefGoogle Scholar
  25. Kumar, A., & Mohanty, S. K. (2011). Socio-economic differentials in childhood immunization in India, 1992–2006. Journal of Population Research, 28, 301–324.CrossRefGoogle Scholar
  26. Malhotra, C., Malhotra, R., Østbye, T., & Subramanian, S. V. (2012). Maternal autonomy and child health care utilization in India: Results from the national family health survey. Asia-Pacific Journal of Public Health, 20, 1–13.Google Scholar
  27. Martín, T. C., & Juárez, F. (1995). The impact of women’s Education on fertility in Latin America: Searching for explanations. International Family Planning Perspectives, 21(52–57), 80.Google Scholar
  28. Measure DHS/ICF International. (2013). Standard Recode manual for DHS 6. Demographic and Health Surveys methodology. United States Agency for International Development (USAID).Google Scholar
  29. Nsungwa-Sabiiti, J., Källander, K., Nsabagasani, X., Namusisi, K., Pariyo, G., Johansson, A., et al. (2004). Local fever illness classifications: Implications for home management of malaria strategies. Tropical Medicine & International Health, 9, 1191–1199.CrossRefGoogle Scholar
  30. Omariba, W. R., Beaujot, R., & Rajulton, F. (2007). Determinants of infant and child mortality in Kenya: An analysis controlling for frailty effects. Population Research and Policy Review, 26, 299–321.CrossRefGoogle Scholar
  31. Othero, D. M., Orago, A. S., Groenewegen, T., Kaseje, D. O., & Otengah, P. A. (2008). Home management of diarrhea among underfives in a rural community in Kenya: household perceptions and practices. East African Journal of Public Health, 5, 142–146.Google Scholar
  32. Pilkington, H., Mayombo, J., Aubouy, N., & Deloron, P. (2004). Malaria, from natural to supernatural: A qualitative study of mothers’ reactions to fever (Dienga, Gabon). Journal of Epidemiology and Community Health, 58, 826–830.CrossRefGoogle Scholar
  33. Pokhrel, S. (2007). Determinants of parental reports of children’s illness: Empirical evidence from Nepal. Social Science and Medicine, 65, 1106–1117.CrossRefGoogle Scholar
  34. Sastry, N., & Burgard, S. (2011). Changes in diarrheal disease and treatment among Brazilian children from 1986 to 1996. Population Research and Policy Review, 30, 81–100.CrossRefGoogle Scholar
  35. Schellenberg, J. A., Victora, C. G., Mushi, A., de Savigny, D., Dachellenberg, D., Mshinda, H., & Bryce, J. (2003). Inequities among the very poor: Health care for children in rural southern Tanzania. Lancet, 361, 561–566.CrossRefGoogle Scholar
  36. Shah, B. D., & Dwivedi, L. K. (2011). Causes of neonatal deaths among tribal women in Gujarat, India. Population Research and Policy Review, 30, 517–536.CrossRefGoogle Scholar
  37. Sharkey, A. B., Chopra, M., Jackson, D., Winch, P. J., & Minkovitz, C. S. (2012). Pathways of care-seeking during fatal infant illnesses in under-resourced South African settings. Transactions of the Royal Society of Tropical Medicine and Hygiene, 106, 110–116.CrossRefGoogle Scholar
  38. Thind, A., & Andersen, R. (2003). Respiratory illness in the Dominical Republic: What are the predictors for health services utilization of young children? Social Science and Medicine, 56, 1173–1182.CrossRefGoogle Scholar
  39. Vikram, K., Vanneman, R., & Desai, S. (2012). Linkages between maternal education and childhood immunizations in India. Social Science and Medicine, 75, 331–339.CrossRefGoogle Scholar
  40. Westoff, C. F., & Koffman, D. A. (2011). The association of television and radio with reproductive behavior. Population and Development Review, 37, 749–759.CrossRefGoogle Scholar
  41. World Health Organization/United Nations Children’s Fund (WHO/UNICEF). (2010). Countdown to 2015 decade report (2000–2010): Taking stock of maternal, newborn and child survival. Geneva: World Health Organization.Google Scholar
  42. World Health Organization/United Nations Children’s Fund (WHO/UNICEF). (2013). Ending preventable child deaths from pneumonia and diarrhoea by 2025: Executive summary. The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD). Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.Department of Demography and SociologyUniversity of California, BerkeleyBerkeleyUSA
  2. 2.Department of SociologyPenn State UniversityState CollegeUSA
  3. 3.Department of SociologyBrigham Young UniversityProvoUSA

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